MyPractice to launch pathway navigator, roll out Health365

Practice management software vendor MyPractice is rolling out a new pathway navigator product across the Auckland and Northland regions, offering GPs an easier way to customise clinical pathways and guidelines for individual patients.

The company is also in the middle of its Health365 roll-out, a patient portal that was piloted last year and has been implemented in a number of practices over the last few months.

MyPractice founder and CEO Ashwin Patel said the pathway navigator involved a different way of presenting clinical guidelines to doctors. It has been developed in collaboration with Healthpoint and will be deployed to both MyPractice and Medtech users.

“It basically takes a complicated pathway and customises that for an individual patient,” Dr Patel said. “It feeds in all of their information and works out on their particular timeline where they are in the scheme of things and then presents what to do next.”

Dr Patel likened it to a GPS for a map, showing doctors how to navigate a particular pathway every time. “It does it on your behalf and says 'this is what we recommend is the best step' and then shows you what the next best steps are and what we don't recommend. So it still allows the doctor to apply all of their judgement as to the actual steps.

“It also collates what they've done so the people writing guidelines can actually see what doctors are doing. We are rolling it out across the Auckland and Northland regions so every GP will have access to it over the next few months.”

MyPractice is also in the middle of a wider roll-out of its Health365 patient portal. While the National Health IT Board (NHITB) is keen to see every patient offered the use of a patient portal by the end of the year, the industry itself has been working on introducing portals for a number of years, Dr Patel said.

“We have been piloting it for a number of months and now we've officially launched it through our practices and we are in the process of rolling it out to all of our sites,” he said.

“It is being supported by [the NHITB] in that they have a similar idea, but it has been in development from our point of view for a lot longer than that. We were involved in some of the workshops that went on a few years ago about what should be in a good patient portal.”

Health365 allows patients to access a range of information held about them in their GP's PMS, including a summary of their problem lists, medications, allergies and immunisations as well as access to their full clinical notes, should their doctor think it appropriate.

It also allows them to make a number of transactions with their GP, including appointment bookings, repeat prescription requests and online consults. In the future, there will be the ability for patients to upload their own health data such as blood pressure and weight measurements should they be using monitoring equipment at home.

It also has a provider arm so hospital emergency departments and after-hours GP services can access the portal, with the patient's permission. Any access by another healthcare provider is logged both in Health365 for the patient to see and in MyPractice's own systems.

While the benefits to patients are obvious, there has been a lot of debate in New Zealand about the cost of implementing patient portals. Health365, like rival systems such as ManageMyHealth, has an upfront installation fee and a monthly subscription fee. However, Dr Patel emphasises that this is balanced by a reduction in administration costs for the practice, as well as the ability to offer more paid services to patients.

“One of the advantages that we've had is that we've had a lot of feedback from both patients and from clinical people involved before we started,” he said. “There has been a lot of effort making sure it works without obstructing people's workflow and there is no more effort for doctors to do online consults or repeat scripts.

“If anything it actually saves the practice a reasonable amount of time and money and offers new revenue streams like online consults that can actually pay for the portal, so it is cost neutral or potentially a revenue earner rather than another burden.”

Dr Patel said the online consults were most commonly instant messaging services. The system has been designed so that the patient pays for the consult the next time they physically come in to the practice rather than through the portal. This policy was adopted in order to avoid merchant fees but more importantly to provide the doctor with flexibility in what he or she charges for each consult and to fit in with the practice's existing billing system, he said.

“The doctor decides what to charge for each consult,” he said. “If they decide it is very minor then they might not charge for it but to decide that for this one it is worth charging for. For most consults it turns out to be about half of the normal consult fee and the patients love it because it is a lot easier than making an appointment, taking time off work and coming in and paying the full fee. If they have simple questions, it is a very appropriate way of servicing them.”

He said billing was done in the same way a practice would bill for a repeat prescription. “The next time you go in you pay for it,” he said. “We've done that rather than make it online because if we did that there is a lot more complexity and you have to set up merchant accounts for various things, but this also means that you have full flexibility for the practice to vary their fees for different things.

“They just put up on the portal how much it is going to cost but the payments are all done using your own billing system. That means they don't have to do it a different way for one thing than for another.”

Dr Patel has been working with the Royal New Zealand College of General Practitioners (RNZCGP), the Medical Council of New Zealand, GPNZ, the primary health organisations and the Ministry of Health on developing a code of practice for the provision of patient portals. One reason is to try to overcome the reluctance of many GPs to allow patients to look at their clinical notes.

“A code of practice will give the GPs a lot more confidence about using this new technology,” Dr Patel said. “It is aimed at making sure they do it in in a safe and robust way. From a medico-legal point of view and from a safety point of view, the issues have been debated and knocked around so by the time the GPs get [a portal] they will have a lot more confidence and they will know they are not venturing into a new area without a lot of support.”

Dr Patel said patients are far more enthusiastic about using portals than doctors, but then again, they don't have to worry about medico-legal obligations.

“Patients who have gone on to the portal have stated that they are really keen on it and they love it, but the doctors' initial fears have mostly been that the patients won't be able to understand what they have written, that they would speculate about the diagnosis or think that the doctor thinks they have got cancer when they are just trying to rule it out.

“There is a little bit of concern about notes written years ago, when doctors didn't think anybody else was going to read them, so some doctors are saying perhaps they should just share notes from now onwards.

“With our system, you have access to all of the notes although for people with some sensitive information, you can be very granular in what you give them access to. It doesn't have to be all or none.

“It is the same thing with dependents – if you give dependents or caregivers access, you might say they could make appointments for me but they can't see my notes, or you can set what level the practice feels is appropriate. It's not an all or none, and that offsets the concerns somewhat.”

He also said the use of patient portals was a safer and easier system than a central repository. There is only one record in existence, it fits in with the capitation system and there is no risk that a patient's medical record will be exposed through a central repository.

“It also means that if you've got a very large practice you are not trying to push up a lot of updates and changes to a repository every night. It is much lighter on traffic and much more secure.”

Posted in New Zealand eHealth

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